Over the many years I’ve been teaching childbirth education, the topic of hiring a doula has come up in every class. By the time my students reach me for a childbirth class some have already hired a doula; while in other classes I often have to explain the definition and importance of using a doula. In simple terms, a doula is a trained professional who provides information, comfort, and support to a woman in labor. Her role is not to be confused with a “midwife” who actually delivers babies as well as handles prenatal and postnatal care for the mom. Doula work is varied and flexible, but ultimately she is defined as “non-medical support.” Her presence at your birth should be accepted by every hospital and every practitioner. The studies indicate that when doulas attend a birth, the labors have fewer complications, we see fewer cesarean sections, and mothers report a more satisfying experience.
How can this be, my students often ask? Is there a magic trick that doulas use to make a labor easier or less complicated?
There IS no magic trick. It’s truly a combination of experience and intuition that guides a doula into effectively helping the laboring mom. Sometimes this is in the traditional sense, by a combination of reassurance or by providing massage just where she needs it. Often it is about understanding hospital protocols and procedures so that they have a minimum impact on her labor. For example, when fetal monitoring is required, the doula can help find more comfortable ways of getting her situated. Sometimes it’s just a more creative way of thinking – like the doula who managed to get her client an epidural when the hospital said, “No epidurals today!” (More on that later…)
Cara Birnbaum from Tapestry Births – a collective of doulas with hundreds of birth stories, elaborates on the topic:
“A lot of our inquiries come from women who know someone who hired a doula and raved about the experience. We also get a lot of referrals from doctors who are starting to view us as part of the birthing team – even asking our advice occasionally on something physical, like pushing positions.” Doulas are not covered by insurance and prices can vary widely based on the doula’s level of experience. When considering a doula it’s helpful to remember you are building a relationship. She should be there for you before, during, and after your birth, providing you with support that most times your practitioner simply does not have time to offer.”
Cara continues, “What a lot of people may not realize is that our support doesn’t only happen during the hours or days before your baby arrives. It starts the day our client signs on. The two lengthy prenatal home visits included in our package give us a chance to get to know one another, explore anxieties and other emotions surrounding birth. We hope to get a deep sense of what comforts expectant moms in their daily lives and practice positions and counter-pressure techniques that are known to work.”
But aren’t doulas really for women who want an unmedicated birth?
Definitely not. If we know anything at all about birth, we know that it is unpredictable. A doula’s emphasis is to support her client through all the twists and turns a birth may take. That could be unmedicated, medically induced, or even a scheduled cesarean. Sometimes the laboring woman just needs some validation of her wishes when her birth is taking an unexpected turn.
Cara recalls, “Our client had been working so hard in the hospital for days and finally said, ‘I’m not sure how much longer I can do this.’ I could tell by the look in her eyes that she was looking to her husband and to me to say, ‘You do what you need to do.’ She wound up asking for an epidural, which turned out to be exactly what she needed at that moment. It gave her a chance to sleep–maybe it even helped her body relax–and she gave birth a few hours later.” Cara’s colleague Lisa recounts how she helped her clients feel “heard and understood” during their births. “I helped her ask the right questions to her doctor that enabled her to move around in labor, which is what she wanted to do. We even were able to get clear fluids in a hospital that is strictly ‘nothing by mouth’ during labor and delivery.”
Bonu DeCaires (fullbirth.com) has years of doula experience and scores of fascinating birth stories to tell. “I like to also focus on the supportive and preventative care a woman can receive from her doula before she ever goes into labor,” Bonu explains. “Based on our meetings and my background in nutrition, we can often enable her to get the best care from her provider and position her for a more satisfying birth experience.” Once at a very busy New York hospital, Bonu’s client (and all the other women in triage) were told they could not be moved into a labor and delivery room until they were 9 cm dilated. Triage (the section where you are evaluated before admission to the labor & delivery unit) is not designed for comfort or movement in labor — nor is it equipped for epidural administration; so those women were a very unhappy and uncomfortable bunch that day. Being an experienced doula with a great deal of hospital familiarity, Bonu asked one of the nurses if her client could be moved to the recovery area outside of the operating room (typically reserved for those recovering from cesarean surgery). In recovery they had all the necessary equipment and monitors for epidural anesthesia.
And, so it was, just like getting upgraded from “Business to First Class” — a doula’s ingenuity and commitment to her client allowed her to get exactly what she needed in that situation.
What if my doctor doesn’t want me to use a doula?
This response can mean a couple of things. One, that perhaps your OB has had experience with an inexperienced doula and found the encounter to be a negative one. Or that your practitioner does not want you to have any say or empowerment in the labor process which is probably the biggest justification for you to hire a doula. More frequently we find that practitioners are delighted to have someone “hold their patient’s hand” during labor. This allows for less stress on the laboring woman and her partner, less need for calling on the hospital’s nursing staff, and more freedom for the doctor to come in and deal with the major issues when and if necessary.
How much does a doula cost and is she covered by insurance?
Doulas are not routinely covered by health insurance though sometimes flex spending can be applied to her fee. Prices for doulas are based mostly on experience and training. In order for certain certification requirements to be fulfilled (for educators and doulas), women have to attend several births. In these cases they are happy to do this at a very low cost and occasionally for free. For a doula in the New York area with a decade or more of births under her belt you can expect to pay between $3,000 – $4,000 for the service. Keep in mind that this includes visits before, during and after your birth. A more mid-range price structure would be anywhere from $900 to $1,500. For doulas who are just beginning their training they might charge $500 or less. Overall, there are only benefits to hiring a doula. In the words of author and educator Erica Lyon, “What I hear consistently from my students is, ‘Thank God we had a doula’ or ‘I wish we had hired a doula.’”
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